Alternativesto these procedures

Angioplasty and stents aren’t the only treatments for coronary artery disease. Here are some alternatives you can discuss with your doctor.

If you have an acute problem with your coronary arteries, urgent treatment is required and exploring alternatives isn’t recommended.

For non-acute problems, there are less invasive methods of diagnosis and treatment than a coronary angiogram, angioplasty and stenting. If treatment isn’t urgent, it’s worth talking to your doctor about these alternatives.

Alternative diagnostic techniques

Before having an angiogram, there are several techniques that can be used to establish whether an angiogram, angioplasty and stenting are right for you:

Stress testing

If you’re able to exercise, an electrocardiogram stress test (Exercise ECG) can be done ahead of an angiogram. If the stress test is negative, you may not need an angiogram.

The stress test is done while you walk on a treadmill or ride a stationary bike. Exercise makes your heart pump faster than normal so a stress test can detect heart problems that wouldn’t be noticeable at rest.

If you can’t exercise, other alternatives include a nuclear or echocardiogram stress test. You can also be given a drug that makes your heart react as though you’re exercising.

Nuclear scan

For this scan, a tiny amount of radioactive material is injected into your bloodstream. While you exercise (or with the drug that simulates exercise), the radioactivity is monitored as it flows through your heart, allowing the doctor to identify blood-flow problems.

Coronary calcium scoring

A calcium score is an imaging technique that uses computed tomography (CT) to reveal the density of plaque in coronary arteries.

Cardiac CT angiography

This relatively new option may be offered to people with moderate risk coronary artery disease and chest pain as it allows doctors to see the entire heart structure, including vessels and chambers. It may be used as a preliminary step before going on to angioplasty and stenting. However, there may be significant out-of-pocket costs as it isn’t fully covered by Medicare or Australian health insurers.

Magnetic resonance imaging (MRI) scan

An MRI scan creates both still and moving pictures of your heart and major blood vessels. Unlike a nuclear scan, it doesn’t use radiation. It’s a useful way to get pictures of your heart as it beats and can diagnose and assess heart disease, damage caused by a heart attack, heart failure, heart valve problems, congenital heart defects and other heart conditions. It may not be suitable if you have a pacemaker or implantable defibrillator.

Fractional flow reserve

A fractional flow reserve test is a useful way of assessing whether angioplasty and stents will be helpful to you. It can be done at the same time as an angiogram.

A thin wire is inserted through the catheter to measure blood flow through areas of suspected narrowing. The doctor can then decide whether angioplasty and stents are necessary. You may still need stents, but possibly not as many. Or your doctor may prescribe medication instead.

Because it’s a relatively simple procedure, fractional flow reserve testing can be less expensive than angioplasty and stents.

Additional treatments

Lifestyle modifications

While stents are effective, they aren’t perfect. Your arteries may narrow again at or near the original site or narrow in other places, requiring further treatment. To reduce the risks, you should talk to your doctor about lifestyle modifications. See Back at home.

Medications

Medication is an effective way to manage heart disease in many people whose symptoms are predictable. Medications include low-dose aspirin and other drugs to lower the risk of blood clots forming in the stent or area of angioplasty, drugs to lower blood pressure and drugs like statins to lower cholesterol. You’ll probably need to take medications for the rest of your life anyway following angioplasty and stenting.

Coronary bypass surgery

A surgical alternative to angioplasty and stents is coronary artery bypass graft surgery. Surgery is much more effective than angiography and stents in certain situations, but coronary artery bypass grafts involve open heart surgery, post-operative pain, scarring and a longer recovery time.

This surgery is often better for more severe disease and for people who have other health considerations that could reduce the effectiveness of stents.

When to seek immediate medical attention

You’ve probably talked to your doctor about what to do if your chest pain doesn’t resolve quickly or if you don’t get relief after taking the maximum number of angina tablets. Be sure to consult your doctor about any heart-related symptoms or concerns. If you have unexplained chest pain or breathlessness, call 000 immediately.